Clinical reference laboratory testing plays a key role in many facets of the healthcare process. Many of the decisions made by healthcare providers regarding patient care, from initial diagnosis through treatment and ultimate prognosis, are dictated by reference laboratory testing. For example, approximately 80% of all diagnoses are associated with a reference laboratory test. Given the crucial and prevalent role of clinical reference laboratory testing in the medical arena, it is imperative that the reference laboratory testing process provide results to healthcare providers in a timely and efficient manner.
While reference laboratory testing may sometimes be performed at the point-of-care, such as at a physician office or hospital, in many cases, the reference laboratory located at the same facility as the point-of-care may not be capable of performing a type of test required or the point-of-care location may not maintain a reference laboratory. In such cases, physical specimens collected from patients must be sent to a distant reference laboratory for testing. Currently, requesting clinical reference laboratory testing from distant reference laboratories and disseminating results are often part of a manual process, which is tedious, inefficient, and error prone. For example, in the context of a physician office requesting reference laboratory testing for a patient, it is often difficult for the physician office to determine an appropriate reference laboratory to perform the testing. Typically, the physician office will maintain information, such as the testing capabilities for each of a number of reference laboratories and records indicating the insurance each reference laboratory accepts. Accordingly, personnel at the physician office must manually review the information and determine an appropriate reference laboratory.
This approach is prone to errors, such as a physical specimen being sent to a reference laboratory that is incapable of performing the test requested and/or that does not accept the patient's insurance. In some cases, requests for reference laboratory testing may be ambiguous or incomplete from the perspective of the reference laboratory performing the testing. For example, if a reference laboratory receives a request to perform testing for hepatitis, the reference laboratory doesn't have sufficient information to know the specific type of hepatitis for which to test. Accordingly, the reference laboratory may perform the incorrect test. Alternatively, the reference laboratory may be required to contact the requesting party (e.g., by telephone) for clarification.
Further, current reporting and tracking of reference laboratory testing results is often not a seamless process. Results reporting is frequently a manual process, such as through mailing, faxing, emailing, or phoning results to the appropriate healthcare provider, providing opportunities for the miscommunication of results. If a healthcare provider does not receive results in a timely manner, the provider typically must call the reference laboratory to determine the status of the results. In cases in which the patient's results need to be reviewed and used for care at multiple healthcare providers, it is typically the burden of the patient to carry the results from institution to institution.
Currently, some larger reference laboratories provide proprietary software and/or hardware for entering orders for reference laboratory testing and for accessing results. In addition, some electronic medical record systems may interface with reference laboratories for order entry and result viewing. However, the software and/or hardware provided by each reference laboratory is specific to that particular reference laboratory. Likewise, for electronic medical record systems, individual interfaces are required for each reference laboratory.
Because individual interfaces are required for each reference laboratory, alias maps must be created for each reference laboratory. The alias maps provide an interface between how the physician office codes a particular test and how each reference laboratory codes the same test. Additional mapping must be provided to ensure a physician office receives the results it expects for the particular test. Attributes associated with each test provide guidance for the physician office acquiring a specimen. There is often variance between these attributes among reference laboratories even for the same test. Typically, a physician office utilizes a minimum of twenty to thirty reference laboratories to satisfy the needs of patients, insurance companies, and testing requirements. Unfortunately, reference laboratories frequently change the codes associated with a given test or type of measurement. Generally, reference laboratories send out code changes once a week, often in excess of two hundred changes a month. Each time a physician office receives the changes from each reference laboratory, a manual process is required to see how many of the code changes affect the physician office receiving the code changes. As a result, many physician offices simply resort to utilizing paper. Even when the physician offices employ an electronic means to interface with the laboratory software and/or hardware, the effort to maintain an accurate alias map for each reference laboratory is time consuming and costly because there is no centralized mapping that can be leveraged between organizations. Exacerbating this problem further is that it is equally time consuming and costly to change reference laboratories should the need arise because new alias maps need to be created each time a physician office changes or adds a reference laboratory.